Legal Consent Plan

LEGAL CONSENT PLAN

This Legal Consent Plan ("Plan") is entered into by and between Client Name: and Plan Administrator Name: with an Effective Date of .

RECITALS

WHEREAS, Client wishes to grant certain consents and authorizations to the Plan Administrator to permit access to, use of, and disclosure of specified information as set forth in this Plan;

WHEREAS, Plan Administrator agrees to manage, apply and, where authorized, disclose such information only as permitted by this Plan and applicable law; and

WHEREAS, the parties desire a written Plan to document the scope, duration, procedures for withdrawal, and the legal obligations governing the consents granted herein.

NOW, THEREFORE, in consideration of the mutual covenants and promises contained in this Plan and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Plan the following terms have the meanings set forth below. "Consent" means a voluntary authorization by Client permitting the use or disclosure of Client information as set forth in this Plan. "Information" means any records, documents, data, communications or materials, whether in paper, electronic, or other form, that are subject to the Consent. "Third Party" means any person or entity other than Client or Plan Administrator.

2. GRANT OF CONSENT

Client hereby grants to Plan Administrator a limited, revocable Consent to collect, access, use, store, and disclose Information to the extent necessary to accomplish the purposes described in this Plan and as permitted by applicable law. The Consent specifically includes the following categories (check all that apply):

Medical Records Legal Documents and Communications Financial Records

Data Sharing for Case Management Other

3. SCOPE OF CONSENT AND AUTHORIZED ACTIONS

The Consent authorizes Plan Administrator to access and disclose Information to Third Parties where such access or disclosure is reasonably necessary to: (a) coordinate legal representation or advice; (b) obtain necessary services or benefits on behalf of Client; (c) comply with court orders or statutory reporting obligations; and (d) facilitate communications with healthcare providers, insurers, trustees, or financial institutions when such communications are essential to the purposes set forth herein. Plan Administrator shall limit disclosures to the minimum information necessary to accomplish the stated purpose.

4. DURATION; TERMINATION

This Plan shall commence on the Effective Date and shall remain in effect until terminated as provided in this section. Client may terminate this Plan at any time by providing written notice to Plan Administrator in accordance with Section 10 (Notices). Termination shall not affect actions taken by Plan Administrator in reliance on a valid Consent prior to receipt of the termination notice. Provisions concerning confidentiality, indemnification and limitations on disclosure shall survive termination to the extent necessary to effectuate their purpose.

5. WITHDRAWAL OF CONSENT

Client may withdraw Consent in whole or in part by delivering a written withdrawal to the Plan Administrator at the address for notices set forth in Section 10. Withdrawal shall be effective upon receipt, except where Plan Administrator has already taken action in reliance on the Consent. Withdrawal shall not negate Plan Administrator's right to retain records as required by law.

6. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that it has the full power, capacity and authority to enter into this Plan and to perform its obligations hereunder. Client warrants that any Consent granted herein is given voluntarily and, to the best of Client's knowledge, will not violate any other legal obligation or third-party right.

7. CONFIDENTIALITY

Plan Administrator shall maintain Information in a secure manner and shall not disclose Information except as permitted by this Plan or required by law. Plan Administrator shall implement reasonable administrative, technical and physical safeguards to protect Information from unauthorized access, use, or disclosure.

8. USE AND DISCLOSURE TO THIRD PARTIES

Where disclosure to a Third Party is necessary, Plan Administrator shall: (a) limit the scope of disclosure to the minimum necessary; (b) require the Third Party to protect the Information in a manner consistent with this Plan; and (c) retain records of disclosures as required by law. The Plan does not authorize disclosure of Information for marketing or unrelated commercial purposes.

9. INDEMNIFICATION

Each party shall indemnify, defend and hold harmless the other from and against any claims, liabilities, losses or expenses, including reasonable attorneys' fees, arising from the indemnifying party's breach of this Plan, willful misconduct, or negligent acts in connection with its performance under this Plan.

10. NOTICES

All notices, consents, withdrawals and other communications required or permitted under this Plan shall be in writing and delivered to the addresses below by hand, certified mail (return receipt requested), or overnight courier. Notices shall be effective upon receipt.

11. AMENDMENTS; WAIVER

This Plan may be amended only by a written instrument signed by both parties. No failure or delay by either party to exercise any right under this Plan shall constitute a waiver of that right unless a written waiver is signed by the party granting such waiver.

12. GOVERNING LAW

This Plan shall be governed by and construed in accordance with the laws of the state specified below, without regard to its conflict of law principles.

13. ENTIRE AGREEMENT

This Plan constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and communications, whether written or oral.

14. SEVERABILITY

If any provision of this Plan is held to be invalid, illegal or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect and shall be construed so as to give effect to the original intent of the parties to the fullest extent permitted by law.

15. COUNTERPARTS AND ELECTRONIC SIGNATURES

This Plan may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Signatures transmitted by electronic means shall be effective as original signatures.

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